As a result, it was found that the mean age of the women was 36.49±7.07 (range between 20-49) and that 42.4% of the women were secondary school/high school graduates. It was determined that the mean age of their spouses was 39.74±7.38 (range between 24-57) and that 48.3% were secondary school/high school graduates (Table 1).

 

It was found that of the women, 98.9% had a pregnancy experience and 43.3% had the first pregnancy experience at an age between 25-29 years. It was determined that 92.7% of the women gestated 1-3 times, that 98.9% had given birth before, and that 70.5% of the first labors were normal vaginal birth. In addition, 91.0% of the women had no history of miscarriage/abortus and only 5.1% (N=18) were found to have a history of curettage. 52.0% of the women were determined to use effective family planning method. It was found that the most preferred method was an intrauterine device (IUD) (48.1%) and that 95.5% of the women could easily reach the methods. It was found that religious beliefs were effective at the rate of 0.6% in determining the number of children, however, material factors were found to be effective at the rate of 17.1% (Table 2).

 

In the research, the mean values of women and their spouses according to some characteristics are as follows: the mean age of the women was 36.49±7.07 (range between 20-49), the mean age of their spouses was 39.74±7.38 (range between 24-57), the mean first marriage age was 23.29±3.85 (range between 16-37), the mean first gestational age was 25.20±3.75 (range between 19-37), the mean number of pregnancies was 1.85±0.91 (range between 0-5), the mean parity was 1.74±0.84 (range between 0-4), the mean number of miscarriages was 0.11±0.38 (range between 0-2), the mean number of curettages was 0.07±0.31 (range between 0-2), the mean number of children planned was 1.78±0.81 (range between 0-5), and the mean number of alive children was 1.78±0.88 (range between 0-6).

 

The number of pregnancies, parity, and the number of miscarriages of women who didn’t have income were found to be significantly higher than those who had income (p<0.05). Moreover, there was no significant difference found between working and non-working women in terms of the number of curettages (p>0.05). It was determined that the mean number of pregnancies and the mean parity of women who had a health problem during pregnancy were significantly lower than those who did not have a history of health problem during pregnancy (p<0.05). It was found that the mean number of pregnancies and mean parity of women who thought that religious beliefs had an effect on determining the number of children was high, and that their mean number of miscarriages and curettages were low. In this group, only the number of miscarriages was found to be significantly different (p<0.05). The mean number of pregnancies, mean parity, and mean number of miscarriages were determined to be significantly higher among the women who did not use any effective family planning (FP) method (2.31, 0.16, 2.14, respectively) compared to those who used (1.42, 1.37, 0.06) (p<0.05). There was no significant difference found in the number of curettages among those who did not use effective FP method (p>0.05) (Table 3).

 

Table 1. Sociodemographic characteristics of women and their partners

	Women		Men
	N=356	%	N=356	%
Age groups
20-24 years	15	4.2	3	0.8
25-34 years	131	36.8	99	27.8
35-44 years	158	44.4	165	46.4
≥ 45 years	52	14.6	89	25.0
Mean age	36.49 ± 7.07 (range: 20-49)		39.74 ± 7.38 (range: 24-57)
Education
Literate	20	5.6	5	1.4
Primary school	78	21.9	58	16.3
Secondary / High school	151	42.4	172	48.3
Higher education (4 years)	93	26.1	105	29.5
Higher education (> 4 years)	14	3.9	16	4.5
Income situation
Yes*	189	53.1	341	95.8
No	167	46.9	15	4.2
Family economic status
Equivalent to income expense	129	36.2
Less than expense income	192	53.9
More than expense income	35	9.8
Family type
Core	328	92.1
Large	20	5.6
Fragmented family	8	2.2
The place where she spends most of her life
Village	43	12.1
Country town	19	5.3
City center	294	82.6
Total	356	100.0

 *Pensioners have been included in this group because they generate revenue.

It was determined that the women whose spouses did not work at an income-generating job used FP methods significantly less, that the women who had difficulty in reaching effective FP methods used these methods significantly less, and that the rate of not using effective FP methods was significantly high among the women who had a higher parity (p<0.05) (Table 4).

 

There was a negative, moderate, significant correlation between the first marriage age and the mean number of pregnancies (r=-0.433, p=0.000). The number of pregnancies was found to increase as the first marriage age of women decreased. Likewise, there was a negative, moderate, significant correlation between the first marriage age and the mean parity (r=-0.404, p=0.000). The parity was found to increase as the first marriage age of women decreased (Table 6).

Table 2. Marriage and obstetric characteristics

	N=356	%
First marriage age group
15-19 years	61	17.1
20-24 years	167	46.9
25-29 years	108	30.3
30-34 years	18	5.1
35-39 years	2	0.6
Pregnancy story
No	4	1.1
Yes	352	98.9
First pregnancy age groups
15-19 years	20	5.6
20-24 years	140	39.3
25-29 years	154	43.3
30-34 years	37	10.4
35-39 years	5	1.4
Number of pregnancy (N=352)
1-3 pregnancies	330	92.7
4-5 pregnancies	22	6.2
Health problems in pregnancy
Yes	81	22.8
No	275	77.2
Birth story
Yes	352	98.9
No	4	1.1
Number of births (N=352)
1-2	296	84.1
3-4	56	15.9
First birth (N=352)
Vaginal	248	70.5
Cesarean section (C/S)	104	29.5
Last birth (N=63)
Vaginal	48	76.2
Cesarean section (C/S)	15	23.8
Number of abortuses (N=32)
None	324	91.0
1 time	24	6.7
2 times	8	2.2
Number of abortions
None	338	94.9
1 time	12	3.4
2 times	6	1.7
Effective family planning method use
Yes	185	52.0
No*	171	48.0
Family planning method* (N=185)
Intrauterine device	89	48.1

Condom	55	29.7
Oral contraceptive	41	22.2
Reaching effective family planning methods
Hard	16	4.5
Easy	340	95.5
The effect of religious belief in determining the number of children
Yes	2	0.6
No	354	99.4
The effect of financial factors in determining the number of children
Yes	61	17.1
No	295	82.9
Total	356	100.0

*Protected by the withdraw method were considered as not using effective methods (N=82).

  

Table 3. Differences between pregnancy, birth, abortus, and abortion numbers with some variables

	N	Pregnancy Number	p	Birth Number	p	Abortus Number	p	Abortion Number	p
		Mean±SD		Mean±SD		Mean±SD		Mean±SD
Income situation*
Yes	189	1.65±0.76	0.000	1.56±0.69	0.000	0.07±0.28	0.050	0.04±0.22	0.058
No	167	2.08±1.01		1.95±0.94		0.16±0.47		0.10±0.39
Health problem in pregnancy*
Yes	81	1.65±0.69	0.010	1.56±0.61	0.006	0.16±0.46	0.263	0.05±0.27	0.554
No	275	1.91±0.96		1.80±0.88		0.10±0.35		0.07±0.32
The effect of religious belief in determining the number of children**
Yes	2	2.00±0.00	0.135	3.00±1.41	0.098	0.50±0.71	0.048	0.00±0.00	0.744
No	354	1.99±0.75		1.73±0.83		0.11±0.38		0.07±0.31
Effective family planning method use*
Yes	185	1.42±0.62	0.000	1.37±0.59	0.000	0.06±0.31	0.016	0.05±0.26	0.243
No	171	2.31±0.95		2.14±0.88		0.16±0.44		0.09±0.36

 *Independent samples t-test. **Mann Whitney U test.

 

Table 4. Differences between some variables and effective family planning method usage status

	Effective family planning method use		χ²*	p
	Yes (%)	No (%)
Income situation of the partner
Yes	181 (53.1)	160 (46.9)	4.016	0.045
No	4 (26.7)	11 (73.3)
Reaching effective family planning methods
Hard	4 (25.0)	12 (75.0)	4.881	0.027
Easy	181 (53.2)	159 (46.8)

 *Chi-square test.

The high fertility level which can increase the risk of maternal-infant death by causing high-risk pregnancy and labor is one of the most important factors that can affect the health of women negatively [14]. The fertility level of the societies can be affected by the biological factors such as general health status of women, menarche and menopausal age, infertility as well as social factors such as first marriage age, ordinary family structure in the society, customs/traditions/beliefs, economic status, educational level and employment status of both women and their spouses, access to family planning methods, and economic burden of the child on the family [2]. Also, the proportion of urbanization (or urban population) and the participation of women in the non-agricultural workforce significantly affect fertility rate [15].

 

With the declaration of the republic in our country, the educational level of women who have taken their rightful place has increased [16]. Education can reduce fertility by leading women to become stronger in society, thus to become one of the decision-makers in the family. Moreover, with the increase in the educational level, women whose labor force participation rate has increased postpone the marriage and birth. As a result, the use of modern birth control methods increases and the number of children desired decreases [6]. In a study conducted with women with a constant educational level, it was reported that the status of having children more than the ideal number decreased as the educational level of the spouses increased [7]. In this study, it was similarly found that the parity and number of pregnancies significantly increased as the educational level of women and their spouses decreased. In the studies conducted in America and Pakistan, it was emphasized that fertility decreased as the level of education increased [8,9]. In a study conducted in Turkey, it was found that the fertility level decreased as the educational level of women and their spouses decreased [2].

 

Since women take the responsibility of childcare from the time of birth, a negative correlation arises between women's fertility preferences and labor force participation. In other words, working women prefer to have less number of children compared to nonworking women or they may postpone the birth decision. This causes the childbearing age of women to increase [17,18]. In this study, it was found that the parity and number of pregnancies of the women who didn’t have income were significantly higher compared to those who had income and that the women whose spouses did not work at an income-generating job used FP methods significantly less. According to this finding, nonworking women not only experienced pregnancy and labor more but also experienced miscarriages more. This suggests the tendency of women who are unable to benefit from health care services due to economic reasons to have a miscarriage in unhealthy conditions, which are very risky in terms of maternal and child health.

 

With the increasing labor force participation of women, the level of income of the family increases, too. This leads to low birth rates [9]. Also, the increase in the cost of children leads to decreased fertility [19]. According to Turkey's Population and Health Research (TNSA) 2013 results, fertility decreases with the increase in the level of welfare. The basic fertility rate was found to be 3.32 among women living in the houses with the lowest level of welfare, while it was 1.72 among women with the highest level of welfare [11]. Similar to literature, the parity and number of pregnancies were found to decrease significantly as the level of income of the family increased.

 

In the study, it was found that the parity and number of pregnancies in women who lived in a village most of the time in their lives was significantly higher than that in women who lived in a town and city and that that the women who had difficulty in reaching effective family planning methods used these methods significantly less. The fact that women who live in a city, thus who are able to have educational opportunities and to participate in working life at the same time oblige women to have less number of children, it requires women to use FP services more effectively [10]. Other reasons behind the low birth rates in the cities are the high cost of living in a city, the cost of child care, and especially the fact that the children cannot contribute to the production in the cities as in the villages [7,18]. However, in general, fertility is still high in places where women generally do not participate in labor, where women's and men's level of education and income are low, where women and children are perceived with traditional value judgments, and where family planning methods are hard to reach [10]. As in Turkey, in societies where women are disadvantaged compared to men in terms of their legal, social, and economic status, policies that empower women to have greater control over their own health, indirectly lowering fertility, are more likely to be met with resistance [20]. Similarly, in TNSA 2013 data, it is stated that women in rural areas in each age group give birth to more children compared to those in urban areas [11].

 

The vast majority of the citizens of the Republic of Turkey are Muslim [11]. In Muslim countries, religious belief is one of the most important factors that affect family planning practices [21]. In Muslim societies, the thought that fertility is controlled by fate is dominant and it is stated that abortion is prohibited in Islam except for medical reasons. Also, in this study, it was found that the mean parity and mean number of pregnancies of women who thought that religious belief is effective on determining the number of children were high and that miscarriage and curettage means were low. Likewise, in the studies conducted in our country, it was seen that the majority of women think that abortion is wrong in religious terms [22,23].

 

The societies where the first marriage age is low are the societies that have a child early and in which fertility is high [24]. As the age at first labor which is an important determinant of general fertility level is lower, so the fertility starts earlier. This means a higher number of children compared to fertility starting later [11]. In this study, it was found that the parity and number of pregnancies increased as the first marriage age of women decreased. Since childbearing at an early age can constraint women from taking advantage of educational opportunities and economic activities, woman's age at first labor can affect both mother's and child's health and welfare [11].

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